小剂量、超小剂量及标准剂量化疗治疗老年人急性髓系白血病的疗效研究

摘要

目的 评价小剂量、超小剂量及标准剂量化疗治疗老年人急性髓系白血病(AML)的疗效,寻找小剂量化疗的适应证.方法 回顾性分析1993年1月至2008年11月收治的77例年龄≥60岁 AML患者的病例资料,分析小剂量、超小剂量和标准剂量化疗的近期和远期疗效.结果 总样本中小剂量、超小剂量组患者的年龄较大、Ps评分较高、白细胞较低,但与标准剂量组比,完全缓解(CR)率、总有效率(ORR)、无事件生存(EFS)率和总生存(OS)率差异均无统计学意义.按照年龄或Ps评分细分亚组,小剂量、超小剂量组在<70岁和PS评分≤2的亚组中,不论近期、远期疗效都明显优于标准剂量组;而在≥70岁和PS评分>2的亚组中,两组疗效差异无统计学意义.进一步分析显示:小剂量化疗并未减少化疗相关死亡,也未增加远期复发的风险.结论 小剂量、超小剂量化疗与标准剂量化疗相比可以改善老年AML患者的预后,而且更适用于年龄较轻、一般情况较好的部分老年患者.%Objective To evaluate the therapeutic effect of low-dose,ultra-low-dose and standard dose chemotherapy for elderly acute myeloid leukemia.Methods A retrospective analysis was performed on 77 elderly AML patients aged 60 years or older.The short-term and long-term effects were compared among low-dose,uhtra-low-dose and standard-dose chemotherapy.Results Although patients receiving low-dose or ultra-low-dose chemotherapy were older,with higher PS scores and lower WBC count,there were no significant differences in CR rate,ORR,EFS or OS between patients who received low-dose/ultra-low-dose chemotherapy and standard-dose chemotherapy.By dividing the total samples into subgroups according to age or PS scores,we found out that patients younger than 70 or with a PS score less than 2 showed a much better prognosis,no matter short-term or long-term,in low-dose／ultra-low-dose group rather than in the standard dose group.While in those patients older than 70 or with a PS score more than 2,the differences between those two groups were not significant.Further analysis showed that low-dose chemotherapy did not reduce treatment related mortality,neither did it increase the risk of long-term relapse.Conclusion Low-dose and ultra-low-dose chemotherapy can improve the prognosis of elder AML patients compared with standard-dose chemotherapy,especially for elderly patients who have a better general state.